SPECIFIC DEFENCES

By virtue of the defence mechanisms, the host is able to recognize, destroy and eliminate
antigenic material (e.g., bacteria, viruses, proteins, etc.) foreign to his own.

The specific defences may be discussed for convenience under the following heads :

1. Active immunity
i) Humoral immunity
ii) Cellular immunity
ii) Combination of the above.

2 . Passive immunity
i) Normal human lg
ii)Specific human lg
ii)Animal antitoxins or antisera.

1. Active immunity
It is the immunity which an individual develops as a result of infection or by specific
immunization and is usually associated with presence of antibodies or cells having a specific
action on the microorganism concerned with a particular infectious disease or on its toxin. In
other words, active immunity depends upon the humoral & cellular response of the host.

2. Passive immunity
When antibodies produced in one body (human or animal) are transferred to another to
induce protection against disease, it is known as passive immunity.

Passive immunity differs from active immunity in the following respects :

(a) immunity is rapidly established
(b) immunity produced is only temporary (days to months) till the antibody is eliminated
from the body,
(c) there is no education of the reticuloendothelial system.

Herd immunity
Herd immunity (or community immunity) describes a type of immunity that occurs when the
vaccination of a portion of population (or herd) provides protection to unprotected
individuals. Herd immunity theory proposes that in diseases passed from individual to
individual, it is difficult to maintain
a chain of infection when large numbers of a population are immune.

For example, whein an infectious disease is introduced into a "virgin" population, that is,
population with a very low or no immunity, the attack and case fatality rates tend to be very
high involving
practically all susceptibles as it had happened.

IMMUNIZING AGENTS
The immunizing agents may be classified as
i) vaccines,
ii) immunoglobulins and
iii) antisera.

VACCINES:
Over the last century, vaccination has been the most effective medical strategy to control
infectious diseases. Vaccine is an immuno-biological substance designed to produce spf!cific
protection against a given disease. It stimulates the production of protective antibody and
other immune mechanisms. Vaccines may be prepared from live modified organisms,
inactivated or killed organisms, extracted cellular fractions, toxoids or combination of these.
 Live vaccines: (e.g., BCG, measles, oral polio)
 Inactivated or killed vaccines (cholera, Typhoid, Cholera, Plague, Pertussis, Innuenza)
 Toxoid/Protein (Diphtheria, Tetanus, Acellular Pertussis)
Etc…

Immunoglobulins
The human immunoglobulin system is composed of 5 major classes (lgG, lgM, lgA, lgD and
lgE) and sub-classes within them. The various classes and sub-classes of immunoglobulins
represent different functional groups that are required to meet different types of antigenic
challenges. All antibodies are immunoglobulins.

Antisera or antitoxins
The term Clntiserum is applied to materials prepared in animals. Originally passive
immunization was achieved by the administration of antisera or antitoxins prepared from
non-human sources such as horses. Since human immunoglobulin preparations exist only for
a small number of diseases, antitoxins prepared from non-human sources (against tetanus,
diphtheria, botulism, gas gangrene and snake bite) are still the mainstay of passive
immunization.

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The cold chain

The "cold chain" is a system of storage and transport of vaccines at low temperature from the
manufacturer to the actual vaccination site. The cold chain system is necessary because
vaccine failure may occur due to failure to store and transport under strict temperature
controls. This is of concern in view of the fairly frequent reports of vaccine preventable
disease occurrence in populations thought to have been well immunized. In other words - the
success of national immunization programme is highly dependant on supply chain system for
delivery of vaccines and equipment, with a functional system that meets 6 rights of supply
chain
- The right vaccine, in the right quantity, at the right place, at the right time, in the right
condition (no temperature breaks in cold chain), and at the right cost.

Cold chain equipment

The cold chain equipment used in Universal Immunization Programme are classified as
follows:

Electrical Cold Chain Equipment

There are equipment of different capacity for storage of vaccines at different levels, which
are dependent on electric supply to maintain the recommended temperature.

1. Walk-in-freezers (WIF)
2. Walk-in-coolers (WIC)
3. Deep freezer (DF)
4. Ice lined refrigerator (ILR)
5. Domestic refrigerator (front load refrigerator)
6. Cold boxes
7. Vaccine carriers
8. Day carriers
9. lee packs
ADVERSE EVENTS FOLLOWING IMMUNIZATION
Vaccines used in national immunization programmes are extremely safe and effective.
However, no immune response is entirely free from the risk of adverse reactions or remote
sequelae.
An AEFI (Adverse Events Following Immunization) is any untoward medical occurrence
which follows immunization and which does not necessarily have a causal relationship with
the usage of the vaccine. The adverse event may be any unfavourable or unintended sign,
abnormal laboratory finding, symptom or disease. Reported adverse events can either be true
adverse events, i.e. really a result of the vaccine or immunization process, or coincidental
events that are not due to the vaccine or immunization process but are temporally associated
with immunization.
In 2012, the Council for International Organizations of Medical Sciences (CIOMS) and
WHO revised the existing classification relevant to cause-specific categorization of AEFis
and a new categorization has been introduced